Tuesday, August 18, 2009

New Jersey takes a better path for treating the mentally ill

New Jersey takes a better path for treating the mentally illPosted by By James Pavle and Kristina Ragosta/Special to The Star-Ledger August 18, 2009 7:25AM

New Jersey created a great opportunity to provide better outpatient treatment for individuals with severe mental illnesses when Gov. Jon Corzine signed Senate Bill No. 735 last Tuesday.

The governor's signature marks years of efforts by supporters to update New Jersey's outdated mental health treatment law. Before the bill was signed, the only option to treat individuals overcome by severe mental illness in New Jersey was one of the state's scarce remaining hospital beds.

Society has a responsibility to help those who cannot help themselves before their illness escalates to tragedy. Medical research now shows that nearly half of those with schizophrenia or bipolar disorder lack insight into their illness. They simply do not realize they are sick and in need of treatment because their brain disease has affected their ability for self-assessment. They cannot recognize that the symptoms of their illness -- hallucinations, delusions, paranoia and withdrawal -- are, in fact, symptoms, not reality.

Since they do not believe they are sick, they see no reason to apply for services and medication that would allow them to recover to a productive, normal life.

New Jersey now joins 42 other states that have improved their mental health treatment laws to allow assisted outpatient treatment as a less restrictive, less costly alternative to hospitalization for individuals suffering from severe mental illness. Such laws authorize a judge, typically only after a showing of medical necessity or danger, to order a person to follow a treatment plan, which can include medication, while living in the community.

Non-compliance with treatment, specifically non-adherence to medication, is strongly associated with hospitalization, arrest and violence among people with severe mental illnesses. Studies and data from states using assisted outpatient treatment laws prove they are effective in reducing these outcomes as well as homelessness, incarceration and victimization.

Assisted outpatient treatment also promotes long-term voluntary compliance. The research shows it can improve the individual's quality of life as well as physical and mental health -- not to mention the benefits for the individuals' families and the surrounding community.

New York is an example of a state that effectively implemented its assisted outpatient treatment law, known as Kendra's Law, which was adopted in 1999. A comprehensive independent evaluation of that law recently conducted for the state confirms that the court orders, in addition to community treatment, work to help those who need it most. This independent evaluation proves that, when implemented effectively, these types of laws can save lives.

The timing of the New Jersey law is critical as the state recently settled a case to release hundreds of psychiatric patients into the community over the next five years. It is well known that New Jersey's state psychiatric hospitals already are severely overcrowded, and readmission rates are estimated to be as high as 36 percent at one of the state hospitals.

County budgets are being adversely impacted by high hospital readmission rates as well, because counties are responsible for 50 percent of the cost of care that their residents receive in state psychiatric hospitals. Assisted outpatient treatment will help to lower hospital readmissions and is needed to reduce overcrowding and budget shortfalls.

The new law provides a great opportunity. Now the state needs to keep the momentum going and ensure that counties use it. The law is scheduled to be phased in over three years. Each year, one-third of the state's counties will implement assisted outpatient treatment. New Jersey counties must put this powerful tool to good use, to improve the lives of individuals suffering from severe mental illness and to prevent further tragedies caused by untreated severe mental illnesses.

James Pavle is executive director and Kristina Ragosta is legislative and policy counsel for the Treatment Advocacy Center, a national nonprofit organization based in Arlington, Va.